A Veteran’s Guide to Medicare Coverage and Enrollment

Medicare eligibility for Veterans

It’s a good idea to check whether you’re eligible for a Medicare plan in addition to your VA healthcare coverage, since the VA’s health benefits may not cover everything you need.

For Veterans to be eligible for Medicare, they must meet at least one of the following criteria:

• be 65 years or older
• have end stage renal disease (ESRD)
• have amyotrophic lateral sclerosis (ALS)
• have mesothelioma

If you have VA benefits, you can choose whether to enroll in Medicare when you become eligible. However, if you choose not to enroll, you will not be covered for any medical services outside of the VA system.

If you choose not to enroll in Medicare you will not lose your VA benefits. In order to keep your TRICARE benefits, however, you must be enrolled in Medicare Part B.

VA healthcare eligibility

If you’re a Veteran, you automatically qualify for some VA healthcare benefits. However, the minimum duty requirement for these benefits is 24 continuous months in the military or having completed your full period of active duty. There are certain circumstances where the minimum requirement may not be necessary, however.

All Veterans can get most types of healthcare services through VA health benefits, and some can qualify for extra benefits, including dental care.

Your coverage will vary depending on:

• the priority group you are assigned based on your income, military service history, disability, and other factors
• the advice of your main doctor, nurse, or other primary care professional
• your medical needs for particular health conditions you have

Medicare and VA benefits

Medicare and VA benefits do not work together. This means that Medicare will not pay for any services you receive from a VA facility.

In order for the VA to cover treatment and services, you must receive them from a VA facility. For Medicare to cover services and treatment, you must receive them from a Medicare-approved facility.

There may be exceptions to these rules. However, they may require pre-authorization.

Medicare coverage for Veterans

There are various ways Medicare can help provide coverage for veterans.

• Medicare Part A covers non-VA emergency hospital care or hospital care for Veterans who live far from a VA facility. It’s usually free with no premium.
• Medicare Part B provides coverage for other non-VA healthcare providers, plus other care and services not covered by VA healthcare plans.

Remember that, if you apply for Medicare Part B after losing VA coverage, a late enrollment fee may apply, so it’s better to apply earlier.

Premiums and funding

Medicare Part A does not typically require a monthly premium. However, Part B does require everyone to pay a premium. The standard premium for Part B in 2025 is $185. This amount may be higher based on your income.

The VA healthcare system could potentially change if Congress reduces funding for the program. Due to this, the VA recommends that veterans enroll in Medicare as soon as they become eligible.

Medicare Advantage, Medigap, and Part D

Some Veterans may choose to enroll in a Medicare Advantage (Part C) plan, Medigap, and Part D plan:

• Medicare Advantage (Part C) covers care and services that aren’t covered by VA and basic Medicare, including dental, hearing, prescriptions, and vision care. However, plans cost more and may have other limitations.
• The Medicare Part D plan is for prescription drugs. It covers some drugs not covered by the VA plan, though the cost of others can be higher than in the VA plan. It can be more convenient for getting prescriptions since it allows you to get them from non-VA doctors and fill them at any retail pharmacy.
• The Medigap plan is a supplementary plan you can use to get healthcare coverage in emergency situations, especially when you’re traveling outside the U.S. It also provides help with certain Original Medicare (Part A and Part B) costs like deductibles, copays, and coinsurance. It can help if you’ve been assigned a lower-priority VA benefit group or you live far from a VA healthcare clinic.

Medicare Advantage, Medigap, and Part D are all provided by Medicare-approved private insurance companies. Part D and Medigap plans are only available to people with Original Medicare.

TRICARE eligibility and coverage

TRICARE is medical insurance for the military.

Several plans exist, and you become eligible for a plan called TRICARE for Life:

• once you turn 65
• after you retire from military service
• if you’re enrolled in Medicare parts A and B

TRICARE is a second payer, meaning that it will cover eligible services after you’ve already received the Medicare coverage you’re eligible for.

Coordination of benefits

If you’re a Veteran, you can get comprehensive coverage by combining both Medicare and VA healthcare benefits, plus TRICARE if you’re eligible.

Medicare is typically the primary payer, but your VA benefits and TRICARE may cover healthcare services not covered by Medicare.

To coordinate your benefits, speak with a VA healthcare specialist. They can help you coordinate your plans based on your needs and budget.

Medicare enrollment for Veterans

Medicare enrollment for Veterans is similar to that of the general population, with some exceptions.

If you’re a Veteran, you’re automatically enrolled in Part A at age 65, if you receive Social Security or Railroad Retirement Board (RRB) benefits. If not, you can enroll via the Social Security Administration (SSA) or RRB.

Veterans can enroll in Medicare Part A during the Initial Enrollment Period (IEP). This is the 7-month period around the time you turn 65. It begins 3 months before your 65th birthday and ends 3 months after.

Part B enrollment is also typically during IEP or later during the General Enrollment Period (January 1 to March 31). It’s important to get your application in on time because late enrollment penalties may apply if you delay enrollment.

An exception to this is if you or your spouse is still working and has health insurance from your current employer. In that case, you can delay enrollment and will not be issued a late enrollment penalty.

You can also enroll for Medicare Part D during IEP or the Annual Enrollment Period (Oct 15 to Dec 7).

Summary

Veterans who wish to have more comprehensive health coverage can have VA benefits, TRICARE, and Medicare at the same time. This means you may be covered for more medical services and can receive treatment at both VA and Medicare-approved facilities.

Once you become eligible for Medicare, you may choose to enroll either in Original Medicare (parts A and B) or Medicare Advantage. It is important to sign up during the proper enrollment periods in order to avoid late enrollment penalties and gaps in coverage.